Vaccines: The Week in Review 17 March 2012 Center for Vaccine Ethics & Policy (CVEP)

This weekly summary targets news, announcements, articles and events in global vaccines ethics and policy gathered from key governmental, NGO and industry sources, key journals and other sources. This summary supports ongoing initiatives of the Center for Vaccine Ethics & Policy, and is not intended to be exhaustive in its coverage. Vaccines: The Week in Review is also posted in pdf form and as a set of blog posts at http://centerforvaccineethicsandpolicy.wordpress.com/. This blog allows full-text searching of some 2,500 entries.. Comments and suggestions should be directed to David R. Curry, MS Editor and Executive Director Center for Vaccine Ethics & Policy david.r.curry@centerforvaccineethicsandpolicy.org

Editors Notes: New issues will now be distributed on Saturdays, allowing for weekend review. A pdf version of this issue is available here: http://centerforvaccineethicsandpolicy.wordpress.com/ Readers can also follow developments on twitter: @vaxethicspolicy

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced a US$340 million contribution by Japan, noting that it is the highest amount that Japan has ever made in 10 years of vigorous support for the Global Fund. Japan is now making its first payment of US$216 million for its 2012 contribution. Gabriel Jaramillo, General Manager of the Global Fund, said, Japan has always been a leader in the fight against disease, but this is a great vote of confidence in our commitment to saving lives. We recognize Japans determination to see real advances in global health, and we are equally determined to deliver. The announcement said Japans leadership in the Global Fund began when a summit of G8 nations called for the creation of such a global financing organization in 2000 in Okinawa, Japan. The contribution received this week raises Japans contributions to the Global Fund to more than US$ 1.6 billion since its creation in 2002. http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-0313_Global_Fund_welcomes_USD_340_million_contribution_by_Japan/

Key Article: Global Immunization Vision and Strategy (GIVS): a mid-term analysis of progress in 50 countries Health Policy and Planning Volume 27 Issue 2 March 2012 Lidija Kamara, Patrick Lydon, Julian Bilous, Jos Vandelaer, Rudi Eggers, Marta GacicDobo, William Meaney and Jean-Marie Okwo-Bele [see abstract in Journal Watch below under Health Policy and Planning ] WHO SAGE Reports: - Extraordinary Meeting on Decade of Vaccines 16-17 February 2012

http://www.who.int/entity/immunization/sage/meetings/2012/february/SAGE_report_Fe b2012_en.pdf - Teleconference on Decade of Vaccines 12 March 2012 http://www.who.int/entity/immunization/sage/meetings/2012/february/Minutes_SAGE_G VAP_teleconference.pdf Review by SAGE of how its input from the extraordinary 16-17 February meeting had been addressed Call for nominations: - To serve on SAGE Working Group on varicella zoster vaccines http://www.who.int/entity/immunization/sage/SAGE_WG_Varicella_Zoster_Vaccines_dra ft_ToRs.pdf Reports: WHO IVB Document Centre Latest Releases 9 March 2012 Report on the WHO Quantitative Immunization and Vaccines related Research (QUIVER) Advisory Committee meeting 6 March 2012 Report of the Ad-hoc consultation on typhoid vaccine introduction and typhoid surveillance

UNICEF, the UN Global Compact and Save the Children announced the Childrens Rights and Business Principles (the Principles) the first comprehensive set of principles to guide companies on the full range of actions they can take in the workplace, marketplace and community to respect and support childrens rights. The Principles are built on existing standards, initiatives and best practices related to business and children, and seek to fill gaps to present a coherent vision for business to maximize the positive impacts and minimize negative impacts on children. In doing so, the Principles help to elaborate both expectations of, and opportunities for business, in relation to children; who are often overlooked as stakeholders of business. The partners launched an extensive multi-stakeholder consultation process involving business, civil society, governments and children across sectors and geographies in developing the principles. Download the Children's Rights and Business Principles: | | English | Franais | Portugus | Press Release: A Call to Business to Respect and Support Children's Rights Watch UN Secretary-General Ban Ki-moon's Message on the Children's Rights and Business Principles Watch an introduction video of the Children's Rights and Business Principles Key Documents Background Note (January 2012) http://www.unglobalcompact.org/Issues/human_rights/childrens_principles.html

The Weekly Epidemiological Record (WER) 16 March 2012 , vol. 87, 11 (pp 97108) includes: Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness http://www.who.int/entity/wer/2012/wer8711.pdf

Twitter Watch [accessed 17 March 2012 - 17:45] Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.
Sandra Rotman Centre @srcglobal Polio transmission continues on Pakistan-Afghanistan border. http://bit.ly/AjUbih http://fb.me/YevPn8fb 12:45 PM - 16 Mar 12 v Eurosurveillance @Eurosurveillanc Ongoing #measles #outbreak in Elche, Spain: http://bit.ly/zbaOsP Retweeted by ECDC 11:27 AM - 16 Mar 1 RIBI @RotaryRIBI #primeminster David Cameron awarded #Rotary's highest honour for commitment to ending #polio. http://www.ribi.org/news/ribi-news/prime-minister-awarded-rotary-shighest-honour Retweeted by EndPolioNow 5:34 AM - 15 Mar 12 IAVI @AIDSvaccine New brief details how IAVI works with partners to build scientific capacity: http://bit.ly/zatmsV #globalhealth #HIV #vaccine 8:57 AM - 15 Mar 12 Measles Initiative @MeaslesInit Warning from the ECDC about Ukraine measles outbreak -5,000+ cases and growing; #Euro 2012 http://ecdc.europa.eu/en/press/news/Lists/News/ECDC_DispForm.aspx? List=32e43ee8-e230-4424-a783-85742124029a&ID=583 9:51 PM - 14 Mar 12 Rotary International @rotary Reflections on #India trip. 172 mil kids get #polio vaccine delivered by 155,000 vehicles, including camels. http://ow.ly/9EWFl Retweeted by EndPolioNow 3:48 PM - 14 Mar 12 RWJF PublicHealth @RWJF_PubHealth Should flu vaccines be required for hospital workers? http://bit.ly/AykKT6 #publichealth

4:31 PM - 14 Mar 12 Arthur Caplan @ArthurCaplan how to kill lots of people with anti-vaccine b.s. http://n.pr/wYq3Cy 9:34 AM - 14 Mar 12

Journal Watch Vaccines: The Week in Review continues its weekly scanning of key journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher. If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org
Annals of Internal Medicine March 6, 2012; 156 (5) http://www.annals.org/content/current [Reviewed earlier; No relevant content] British Medical Bulletin Volume 101 Issue 1 March 2012 http://bmb.oxfordjournals.org/content/current [Reviewed last week] British Medical Journal 17 March 2012 (Vol 344, Issue 7848) http://www.bmj.com/content/344/7848 [No relevant content] Bulletin of the World Health Organization Volume 90, Number 3, March 2012, 157-244 http://www.who.int/bulletin/volumes/90/3/en/index.html The global burden of cholera Mohammad Ali, Anna Lena Lopez, Young Ae You, Young Eun Kim, Binod Sah, Brian Maskery & John Clemens Objective To estimate the global burden of cholera using population-based incidence data and reports. Methods

Countries with a recent history of cholera were classified as endemic or non-endemic, depending on whether they had reported cholera cases in at least three of the five most recent years. The percentages of the population in each country that lacked access to improved sanitation were used to compute the populations at risk for cholera, and incidence rates from published studies were applied to groups of countries to estimate the annual number of cholera cases in endemic countries. The estimates of cholera cases in non-endemic countries were based on the average numbers of cases reported from 2000 to 2008. Literature-based estimates of cholera case-fatality rates (CFRs) were used to compute the variance-weighted average cholera CFRs for estimating the number of cholera deaths. Findings About 1.4 billion people are at risk for cholera in endemic countries. An estimated 2.8 million cholera cases occur annually in such countries (uncertainty range: 1.44.3) and an estimated 87 000 cholera cases occur in non-endemic countries. The incidence is estimated to be greatest in children less than 5 years of age. Every year about 91 000 people (uncertainty range: 28 000 to 142 000) die of cholera in endemic countries and 2500 people die of the disease in non-endemic countries. Conclusion The global burden of cholera, as determined through a systematic review with clearly stated assumptions, is high. The findings of this study provide a contemporary basis for planning public health interventions to control cholera. Cost Effectiveness and Resource Allocation (Accessed 17 March 2012) http://www.resource-allocation.com/ [No new relevant content] Emerging Infectious Diseases Volume 18, Number 3March 2012 http://www.cdc.gov/ncidod/EID/index.htm [Reviewed earlier; No relevant content] Foreign Affairs March/April 2012 Volume 91, Number 2 http://www.foreignaffairs.com/ Essay Why We Still Need the World Bank Robert B. Zoellick More than 60 years after the World Bank was founded, developing countries still turn to it for financing and expertise. But the world is changing, and so must the bank, argues its president. Global Health Winter 2012

http://www.globalhealthmagazine.com/in_this_issue/ [Reviewed earlier] Globalization and Health [Accessed 17 March 2012] http://www.globalizationandhealth.com/ Review Development cooperation for health: reviewing a dynamic concept in a complex global aid environment Peter S Hill, Rebecca Dodd, Scott Brown and Just Haffeld Globalization and Health 2012, 8:5 doi:10.1186/1744-8603-8-5 Published: 15 March 2012 Abstract (provisional) The 4th High Level Forum on Aid Effectiveness, held in Busan, South Korea in November 2011 again promised an opportunity for a "new consensus on development cooperation" to emerge. This paper reviews the recent evolution of the concept of coordination for development assistance in health as the basis from which to understand current discourses. The paper reviews peer-reviewed scientific literature and relevant 'grey' literature, revisiting landmark publications and influential authors, examining the transitions in the conceptualisation of coordination, and the related changes in development assistance. Four distinct transitions in the understanding, orientation and application of coordination have been identified: coordination within the sector, involving geographical zoning, sub-sector specialisation, donor consortia, project co-financing, sector aid, harmonisation of procedures, ear-marked budgetary support, donor agency reform and inter-agency intelligence gathering; sector-wide coordination, expressed particularly through the Sector-Wide Approach; coordination across sectors at national level, expressed in the evolution of Poverty Strategy Reduction Papers and the national monitoring of the Millennium Development Goals; and, most recently, global-level coordination, embodied in the Paris Principles, and the emergence of agencies such as the International Health Partnerships Plus. The transitions are largely but not strictly chronological, and each draws on earlier elements, in ways that are redefined in the new context. With the increasing complexity of both the territory of global health and its governance, and increasing stakeholders and networks, current imaginings of coordination are again being challenged. The High Level Forum in Busan may have been successful in recognising a much more complex landscape for development than previously conceived, but the challenges to coordination remain. The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. Health Affairs March 2012; Volume 31, Issue 3 http://content.healthaffairs.org/content/current [Reviewed earlier; No relevant content] Health and Human Rights

Vol 13, No 2 (2011) December http://hhrjournal.org/index.php/hhr [Reviewed earlier] Health Economics, Policy and Law Volume 7 - Issue 02 - April 2012 http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue [Reviewed earlier] Health Policy and Planning Volume 27 Issue 2 March 2012 http://heapol.oxfordjournals.org/content/current Advance Access Global Immunization Vision and Strategy (GIVS): a mid-term analysis of progress in 50 countries Lidija Kamara1,*, Patrick Lydon1, Julian Bilous2, Jos Vandelaer3, Rudi Eggers1, Marta Gacic-Dobo1, William Meaney4 and Jean-Marie Okwo-Bele1 Author Affiliations 1Immunization Vaccines and Biologicals Department (IVB), Expanded Program on Immunization (EPI), World Health Organization, Geneva, Switzerland, 2Geneva Switzerland, 3Health Program Division, UNICEF, New York, USA, 4Athlone Institute of Technology, Athlone, Ireland *Corresponding author. Immunization Vaccines and Biologicals Department (IVB), Expanded Program on Immunization (EPI), World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27 Switzerland. Tel: +41 22 791 2145. Fax: +41 22 791 4384. Accepted November 29, 2011. Abstract Within the overall framework set out in the Global Immunization Vision and Strategy (GIVS) for the period 20062015, over 70 countries had developed comprehensive Multi-Year Plans (cMYPs) by 2008, outlining their plans for implementing the GIVS strategies and for attaining the GIVS Goals at the midpoint in 2010 or earlier. These goals are to: (1) reach 90% and 80% vaccination coverage at national and district level, respectively; and (2) reduce measles-related mortality by 90% compared with the 2000 level. Fifty cMYPs were analysed along the four strategic areas of the GIVS: (1) protecting more people in a changing world; (2) introducing new vaccines and technologies; (3) integrating immunization, other health interventions and surveillance in the health system context; and (4) immunizing in the context of global interdependence. By 2010, all 50 countries planned to have introduced hepatitis B (HepB) vaccine, 48 the Haemophilus influenzae type B (Hib) vaccine and only a few countries had firm plans to introduce pneumococcal or rotavirus vaccines. Countries seem to be inadequately prepared in terms of cold-chain requirements to deal with the expected increases in storage that will be required for vaccines, and in making provisions to establish a corresponding surveillance system for planned new vaccine introductions. Immunization contacts are used to deliver other health interventions, especially in the countries in the World Health Organization (WHO) Africa Region. The cost for the planned immunization activities will double to U$27 per infant, of which U$5 per infant is the expected

shortfall. Global Alliance for Vaccines and Immunization (GAVI) funding is becoming the largest contributor to immunization programmes. Human Vaccines & Immunotherapeutics (formerly Human Vaccines) Volume 8, Issue 3 March 2012 http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/3/ [Reviewed last week] International Journal of Infectious Diseases Volume 16, Issue 4, Pages e225-e310 (April 2012) http://www.sciencedirect.com/science/journal/12019712 [No relevant content] JAMA March 14, 2012, Vol 307, No. 10, pp 997-1098 http://jama.ama-assn.org/current.dtl [No relevant content] Journal of Infectious Diseases Volume 205 Issue 7 April 1, 2012 http://www.journals.uchicago.edu/toc/jid/current [Reviewed last week] The Lancet Mar 17, 2012 Volume 379 Number 9820 p977 1074 e36 - 42 http://www.thelancet.com/journals/lancet/issue/current Comment The CDC's Center for Global Health Thomas R Frieden, Kevin M De Cock Preview The strategy of the recently established Center for Global Health (CGH) at the US Centers for Disease Control and Prevention (CDC) is to enhance the public health capacity of global partners, increase global health security, and maximise the health impact of specific programmes and interventions through a focus on scientific rigour, scalability, and sustainability. We welcome the opportunity to describe the work of CGH1 and are committed to continuing to increase our impact. The Lancet Infectious Disease Mar 2012 Volume 12 Number 3 p167 - 254 http://www.thelancet.com/journals/laninf/issue/current [Reviewed earlier]

Medical Decision Making (MDM) JanuaryFebruary 2012; 32 (1) http://mdm.sagepub.com/content/current [Reviewed earlier] Nature Volume 483 Number 7389 pp245-368 15 March 2012 http://www.nature.com/nature/current_issue.html [No relevant content] Nature Medicine March 2012, Volume 18 No 3 pp323-467 http://www.nature.com/nm/journal/v18/n3/index.html [Reviewed earlier] Nature Reviews Immunology March 2012 Vol 12 No 3 http://www.nature.com/nri/journal/v12/n3/index.html [Reviewed earlier; No relevant content] New England Journal of Medicine March 15, 2012 Vol. 366 No. 11 http://content.nejm.org/current.shtml [No relevant content] OMICS: A Journal of Integrative Biology March 2012, 16(3) http://online.liebertpub.com/toc/omi/16/3 Opportunities and Challenges for the Life Sciences Community Eugene Kolker, Elizabeth Stewart, Vural Ozdemir OMICS: A Journal of Integrative Biology. March 2012, 16(3): 138-147. Abstract Twenty-first century life sciences have transformed into data-enabled (also called dataintensive, data-driven, or big data) sciences. They principally depend on data-, computation-, and instrumentation-intensive approaches to seek comprehensive understanding of complex biological processes and systems (e.g., ecosystems, complex diseases, environmental, and health challenges). Federal agencies including the National Science Foundation (NSF) have played and continue to play an exceptional leadership role by innovatively addressing the challenges of data-enabled life sciences. Yet even more is required not only to keep up with the current developments, but also to proactively enable future research needs. Straightforward access to data, computing, and analysis resources will enable true democratization of research competitions; thus

investigators will compete based on the merits and broader impact of their ideas and approaches rather than on the scale of their institutional resources. This is the Final Report for Data-Intensive Science Workshops DISW1 and DISW2. The first NSF-funded Data Intensive Science Workshop (DISW1, Seattle, WA, September 1920, 2010) overviewed the status of the data-enabled life sciences and identified their challenges and opportunities. This served as a baseline for the second NSF-funded DIS workshop (DISW2, Washington, DC, May 1617, 2011). Based on the findings of DISW2 the following overarching recommendation to the NSF was proposed: establish a community alliance to be the voice and framework of the data-enabled life sciences. After this Final Report was finished, Data-Enabled Life Sciences Alliance (DELSA, www.delsall.org) was formed to become a Digital Commons for the life sciences community. The Pediatric Infectious Disease Journal March 2012 - Volume 31 - Issue 3 pp: 217-286,e52-e58,A11-A12 http://journals.lww.com/pidj/pages/currenttoc.aspx [Reviewed earlier] Pediatrics March 2012, VOLUME 129 / ISSUE 3 http://pediatrics.aappublications.org/current.shtml [Reviewed earlier] Pharmacoeconomics April 1, 2012 - Volume 30 - Issue 4 pp: 257-353 http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx Original Research Articles Selecting a Mix of Prevention Strategies against Cervical Cancer for Maximum Efficiency with an Optimization Program Demarteau, Nadia; Breuer, Thomas; Standaert, Baudouin Pharmacoeconomics. 30(4):337-353, April 1, 2012. doi: 10.2165/11591560-000000000-00000 Abstract: Background: Screening and vaccination against human papillomavirus (HPV) can protect against cervical cancer. Neither alone can provide 100% protection. Consequently it raises the important question about the most efficient combination of screening at specified time intervals and vaccination to prevent cervical cancer. Objective: Our objective was to identify the mix of cervical cancer prevention strategies (screening and/or vaccination against HPV) that achieves maximum reduction in cancer cases within a fixed budget. Methods: We assessed the optimal mix of strategies for the prevention of cervical cancer using an optimization program. The evaluation used two models. One was a Markov cohort model used as the evaluation model to estimate the costs and outcomes of 52 different prevention strategies. The other was an optimization model in which the results of each prevention strategy of the previous model were entered as input data. The latter model determined the combination of the different prevention options to

minimize cervical cancer under budget, screening coverage and vaccination coverage constraints. We applied the model in two countries with different healthcare organizations, epidemiology, screening practices, resource settings and treatment costs: the UK and Brazil. 100000 women aged 12 years and above across the whole population over a 1year period at steady state were included. The intervention was papanicolaou (Pap) smear screening programmes and/or vaccination against HPV with the bivalent HPV 16/18 vaccine (Cervarix [Cervarix is a registered trademark of the GlaxoSmithKline group of companies]). The main outcome measures were optimal distribution of the population between different interventions (screening, vaccination, screening plus vaccination and no screening or vaccination) with the resulting number of cervical cancer and associated costs. Results: In the base-case analysis (= same budget as today), the optimal prevention strategy would be, after introducing vaccination with a coverage rate of 80% in girls aged 12 years and retaining screening coverage at pre-vaccination levels (65% in the UK, 50% in Brazil), to increase the screening interval to 6 years (from 3) in the UK and to 5 years (from 3) in Brazil. This would result in a reduction of cervical cancer by 41% in the UK and by 54% in Brazil from pre-vaccination levels with no budget increase. Sensitivity analysis shows that vaccination alone at 80% coverage with no screening would achieve a cervical cancer reduction rate of 20% in the UK and 43% in Brazil compared with the pre-vaccination situation with a budget reduction of 30% and 14%, respectively. In both countries, the sharp reduction in cervical cancer is seen when the vaccine coverage rate exceeds the maximum screening coverage rate, or when screening coverage rate exceeds the maximum vaccine coverage rate, while maintaining the budget. As with any model, there are limitations to the value of predictions depending upon the assumptions made in each model. Conclusions: Spending the same budget that was used for screening and treatment of cervical cancer in the pre-vaccination era, results of the optimization program show that it would be possible to substantially reduce the number of cases by implementing an optimal combination of HPV vaccination (80% coverage) and screening at prevaccination coverage (65% UK, 50% Brazil) while extending the screening interval to every 6 years in the UK and 5 years in Brazil. PLoS One [Accessed 17 March 2012] http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413 369CD6F3.ambra01?field=date Does Consideration and Assessment of Effects on Health Equity Affect the Conclusions of Systematic Reviews? A Methodology Study Vivian Welch, Mark Petticrew, Erin Ueffing, Maria Benkhalti Jandu, Kevin Brand, Bharbhoor Dhaliwal, Elizabeth Kristjansson, Janet Smylie, George Anthony Wells, Peter Tugwell PLoS ONE: Research Article, published 13 Mar 2012 10.1371/journal.pone.0031360 Abstract Introduction Tackling health inequities both within and between countries remains high on the agenda of international organizations including the World Health Organization and local,

regional and national governments. Systematic reviews can be a useful tool to assess effects on equity in health status because they include studies conducted in a variety of settings and populations. This study aims to describe the extent to which the impacts of health interventions on equity in health status are considered in systematic reviews, describe methods used, and assess the implications of their equity related findings for policy, practice and research. Methods We conducted a methodology study of equity assessment in systematic reviews. Two independent reviewers extracted information on the reporting and analysis of impacts of health interventions on equity in health status in a group of 300 systematic reviews collected from all systematic reviews indexed in one month of MEDLINE, using a pretested data collection form. Any differences in data extraction were resolved by discussion. Results Of the 300 systematic reviews, 224 assessed the effectiveness of interventions on health outcomes. Of these 224 reviews, 29 systematic reviews assessed effects on equity in health status using subgroup analysis or targeted analyses of vulnerable populations. Of these, seven conducted subgroup analyses related to health equity which were reported in insufficient detail to judge their credibility. Of these 29 reviews, 18 described implications for policy and practice based on assessment of effects on health equity. Conclusion The quality and completeness of reporting should be enhanced as a priority, because without this policymakers and practitioners will continue lack the evidence base they need to inform decision-making about health inequity. Furthermore, there is a need to develop methods to systematically consider impacts on equity in health status that is currently lacking in systematic reviews. Efficacy of Vaccination against HPV Infections to Prevent Cervical Cancer in France: Present Assessment and Pathways to Improve Vaccination Policies Laureen Ribassin-Majed, Rachid Lounes, Stephan Clmenon PLoS ONE: Research Article, published 12 Mar 2012 10.1371/journal.pone.0032251 Abstract Background Seventy percent of sexually active individuals will be infected with Human Papillomavirus (HPV) during their lifetime. These infections are incriminated for almost all cervical cancers. In France, 3,068 new cases of cervical cancer and 1,067 deaths from cervical cancer occurred in 2005. Two vaccines against HPV infections are currently available and vaccination policies aim to decrease the incidence of HPV infections and of cervical cancers. In France, vaccine coverage has been reported to be low. Methods We developed a dynamic model for the heterosexual transmission of Human Papillomavirus types 16 and 18, which are covered by available vaccines. A deterministic model was used with stratification on gender, age and sexual behavior. Immunity obtained from vaccination was taken into account. The model was calibrated using French data of cervical cancer incidence. Results In view of current vaccine coverage and screening, we expected a 32% and 83% reduction in the incidence of cervical cancers due to HPV 16/18, after 20 years and 50

years of vaccine introduction respectively. Vaccine coverage and screening rates were assumed to be constant. However, increasing vaccine coverage in women or vaccinating girls before 14 showed a better impact on cervical cancer incidence. On the other hand, performing vaccination in men improves the effect on cervical cancer incidence only moderately, compared to strategies in females only. Conclusion While current vaccination policies may significantly decrease cervical cancer incidence, other supplementary strategies in females could be considered in order to improve vaccination efficacy. PLoS Medicine (Accessed 17 March 2012) http://www.plosmedicine.org/article/browse.action?field=date Guidance for Evidence- Informed Policies about Health Systems: Linking Guidance Development to Policy Development John N. Lavis, John-Arne Rttingen, Xavier Bosch-Capblanch, Rifat Atun, Fadi El-Jardali, Lucy Gilson, Simon Lewin, Sandy Oliver, Pierre Ongolo-Zogo, Andy Haines Policy Forum, published 13 Mar 2012 doi:10.1371/journal.pmed.1001186 Summary Points - Contextual factors are extremely important in shaping decisions about health systems, and policy makers need to work through all the pros and cons of different options before adopting specific health systems guidance. - A division of labour between global guidance developers, global policy developers, national guidance developers, and national policy developers is needed to support evidence-informed policy-making about health systems. - A panel charged with developing health systems guidance at the global level could best add value by ensuring that its output can be used for policy development at the global and national level, and for guidance development at the national level. - Rigorous health systems analyses and political systems analyses are needed at the global and national level to support guideline and policy development. - Further research is needed into the division of labour in guideline development and policy development and on frameworks for supporting system and political analyses. This is the second paper in a three-part series in PLoS Medicine on health systems guidance. PNAS - Proceedings of the National Academy of Sciences of the United States of America (Accessed 17 March 2012) http://www.pnas.org/content/early/recent [No new relevant content] Public Health Ethics Volume 4 Issue 3 November 2011

http://phe.oxfordjournals.org/content/current [Reviewed earlier] Science 16 March 2012 vol 335, issue 6074, pages 1269-1396 http://www.sciencemag.org/current.dtl [No relevant content]

Tropical Medicine & International Health March 2012 Volume 17, Issue 3 Pages 263403 http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue [Reviewed earlier] Vaccine http://www.sciencedirect.com/science/journal/0264410X Volume 30, Issue 16 pp. 2605- 2706 (30 March 2012) Regular papers Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: Findings from the 20062008 National Survey of Family Growth Original Research Article Pages 2676-2682 Nicole C. Liddon, Julia E. Hood, Jami S. Leichliter Abstract Background and purpose HPV vaccine coverage for females has increased in the U.S., although challenges to achieving high coverage remain. HPV vaccine coverage continues to lag behind that of other routinely recommended adolescent vaccines and these gaps in coverage are widening. To inform strategies to improve uptake, we explore correlates of vaccine intention and describe reasons for refusing HPV vaccination among unvaccinated females in a nationally representative sample of adolescents and young adults during early stages of HPV vaccine availability. Methods In 20072008, 1243 females aged 1524 years were asked about HPV vaccination in the National Survey of Family Growth (NSFG). For unvaccinated women (n = 955), we evaluated demographic and sexual behavior correlates of likelihood to receive the vaccine in the next 12 months in bivariate and multivariable analyses by age. Correlates to the main reasons for foregoing vaccination are described. Results A minority (42.5%) of unvaccinated respondents said they intended to receive HPV vaccine in the next 12 months: 37.6% of adolescents (1519 years) and 42.0% of young adults (2024 years). Sexually experienced women were more than twice as likely as non-sexually experienced women to intend to receive HPV vaccine (1519 years: aOR = 2.39, 95% CI = 1.15, 4.94; 2024 years: aOR = 2.17, 95% CI = 1.08,

4.33). Having health insurance was associated with being likely to receive HPV vaccine among adolescents. Hispanic young adults were more likely than non-Hispanic Whites to be likely to receive HPV vaccine. The belief of not being at risk for HPV and institutional barriers were the two most commonly cited reasons for foregoing vaccination. Among unvaccinated women who did not intend to get vaccinated, respondents who never had sex were more likely to report not being at risk as the main reason for not needing the vaccine compared to women with sexual experience (44.5 vs. 24.4%) but this finding was only marginally significant in our limited sample. Conclusion In the first years immediately post-licensure of an HPV vaccine, the majority of unvaccinated women indicated that they were unlikely to seek vaccination. Intent to receive the HPV vaccine is tied to sexual experience and most women who do not intend to get vaccinated and have never had sex believe they are not at risk of HPV or do not need an HPV vaccine. These findings highlight the need to better communicate information regarding lifetime risk for HPV and the importance of receiving HPV vaccine prior to sexual initiation. These findings should inform strategies to increase vaccine uptake. Vaccine Volume 30, Issue 15 pp. 2499-2604 (28 March 2012) Regular papers Contribution of Immunization Weeks toward improving coverage, access to services, and completion of recommended childhood vaccinations in Assam, India Original Research Article Pages 2551-2555 Tove K. Ryman, Ajay Trakroo, J.B. Ekka, Margaret Watkins Abstract Recommended childhood vaccines have typically been provided through routine immunization programs. Recently, implementation of strategies that use campaign-like features for providing all the recommended childhood immunizations have been utilized to increase vaccination coverage. Between January 2006 and January 2008, Assam, India, conducted Immunization Weeks (IWs), a periodic campaign-like approach for providing the recommended childhood vaccines generally administered through the routine Universal Immunization Program (UIP). Using data from a household vaccination coverage survey conducted in 5 districts of Assam in late-2007/early-2008 among children 1228 months of age, a secondary analysis was conducted for a subset of children with vaccination cards to assess the impacts of implementing the IW-strategy. Sixty-five percent of the 3310 surveyed children received at least one vaccine dose through an IW. Without IWs, coverage would likely have been lower for all vaccines (e.g., 75% measles vaccine coverage including IWs doses and an estimated 61% without IWs). The proportion of children receiving at least one IW dose was significantly different depending on the child's residence; 72% in hard-to-reach char areas, 66% in rural areas and 53% in urban areas (p = 0.01). Overall, 2085 (63%) of children were fully vaccinated; of these 60% received a combination of IW and UIP doses, 35% received doses only through the UIP, and 5% received doses only through IWs. A delay in administration later than the recommended ages was found for both UIP doses and for IW doses (e.g., for measles vaccine, UIP doses were 6.9 weeks delayed and IW

doses 13.6 weeks delayed). Among this sample of vaccinated children, IWs appeared to increase vaccination coverage and improve access to services in hard-to-reach areas. However, the UIP appeared to be a better system for ensuring that children received all doses in the recommended vaccination series. Evaluation of cost-effectiveness of live oral pentavalent reassortant rotavirus vaccine introduction in Gha na Original Research Article Pages 2582-2587 Collette Abbott, Benjamin Tiede, George Armah, Adel Mahmoud Abstract Background Globally, rotavirus gastroenteritis is the most common identifiable cause of severe diarrhea in children under 5. Recently introduced rotavirus vaccines from Merck & Co. and GlaxoSmithKline have the potential to save hundreds of thousands of lives. Efficacy results in Ghana suggest Merck & Co.s live oral pentavalent rotavirus vaccine (RotaTeq) prevents 65.0% of severe gastroenteritis due to rotavirus infection in children under 5. The announcement by Merck and GSK to make their rotavirus vaccines available for developing nations at reduced prices provides Ghana with the opportunity to introduce rotavirus vaccines into the national immunization program after investigation of the medical, economic and political implications. Methods We estimated the average costs of treating children with diarrhea in the Ashanti region of Ghana as inpatients and outpatients. Using these results, data from rotavirus surveillance studies, and recent rotavirus vaccine efficacy evaluation, we estimated the cost-effectiveness of introducing RotaTeq in Ghana. Results Based on our prospective calculations, we estimated an average inpatient and outpatient costs of $233.97 and $17.09, respectively, for treating childhood diarrhea. Using the 2003 birth cohort, RotaTeq introduction could save 1554 lives and avert 93,109 disability-adjusted life-years (DALYs) annually. At a market price of $5 per dose, introducing RotaTeq would have a base-case cost of $62.26 per DALY averted, at a market price of $3.50 per dose, a base-case cost of $39.59 per DALY averted and at market cost of $1 per dose, a base-case cost of $1.81 per DALY averted. All three values are below the 2009 Ghana per capita GDP. Thus, RotaTeq introduction into Ghana will be very cost-effective. Sensitivity analyses suggest these results are robust. Conclusions RotaTeq vaccination for children under five in Ghana would be a highly cost-effective public health intervention. Ghanaian health officials should seek GAVI funding and evaluate how to maximize RotaTeq access. Establishment of a National Immunization Technical Advisory Group in Cte dIvoire: Process and lessons learne d Original Research Article Pages 2588-2593 Julia Blau, Papa Coumba Faye, Kamel Senouci, Simplice Ncho Dagnan, Alfred Douba, Jeanine Tagliante Saracino, Bradford D. Gessn Abstract In January 2010, Cte dIvoire became the first GAVI-eligible country in sub-Saharan Africa to establish a National Immunization Technical Advisory Group (NITAG). The Cte

dIvoire National Committee of Independent Experts for Vaccination and Vaccines (CNEIV-CI) was created to strengthen national capacity for evidence-based policy decisions with regard to immunization and vaccines. The primary reasons for success in Cte dIvoire were a strong political will, the availability of sufficient national expertise, a step-by-step country-driven process, and the provision of technical assistance to the Ministry of Health. The challenges included operating within the socio-political crisis, and initial reluctance from some stakeholders due to the potential overlap with other existing committees. The latter rapidly dissolved over the course of numerous meetings held with the SIVAC Initiative to clarify the mandate of a NITAG. Vaccine Volume 30, Issue 14 pp. 2397- 2498 (23 March 2012) Regular Papers Barriers to and facilitators of child influenza vaccine Perspectives from parents, teens, marketing and healthcare professionals Original Research Article Pages 2448-2452 Kavitha Bhat-Schelbert, Chyongchiou Jeng Lin, Annamore Matambanadzo, Kristin Hannibal, Mary Patricia Nowalk, Richard K. Zimmerma Abstract Background The CDC recommends annual influenza vaccination for all children age 6 months and older, yet vaccination rates remain modest. Effective strategies to improve influenza vaccination for children are needed. Methods Eight focus groups with 91 parents, teens, pediatric healthcare staff and providers, and immunization and marketing experts were conducted, audiotaped, transcribed verbatim, and coded based on grounded theory. Results Three themes emerged: barriers, facilitators, and strategies. Barriers included fear, misinformation, and mistrust, with exacerbation of these barriers attributed to media messages. Many considered influenza vaccination unnecessary and inconvenient, but would accept vaccination if recipients or other family members were considered high risk, if recommended by their doctor or another trusted person, or if offered or mandated by the school. Access to better information regarding influenza disease burden and vaccine safety and efficacy were notable facilitators, as were prevention of the inconvenience of missing work or important events, and if the child requests to receive the vaccine. Marketing strategies included incentives, jingles, videos, wearable items, strategically-located information sheets or posters, and promotion by informed counselors. Practice-based strategies included staff buy-in, standing orders protocols, vaccination clinics, and educational videos. Teen-specific strategies included message delivery through schools, texting, internet, and social networking sites. Conclusion To improve influenza vaccination rates for children using practice-based interventions, participants suggested campaigns that provide better information regarding the vaccine, the disease and its implications, and convenient access to vaccination. Strategies targeting adolescents should use web-based social marketing technologies and campaigns based in schools.

Is the pneumococcal vaccine Advance Market Commitment motivating innovation and increasing manufacturing capacity? Some preliminary answers Original Research Article Pages 2462-2466 Jens Plahte Abstract This paper seeks to give some preliminary evidence on the potential outcome of the pneumococcal vaccine Advance Market Commitment (AMC), with a focus on its impact on innovation in emerging vaccine manufacturers in developing countries. The evidence is derived from a series of interviews with executives at industrial vaccine developing organizations with pneumococcal vaccines in their R&D portfolio, including both multinational pharmaceutical companies and emerging manufacturers. The main findings are that so far there is no evidence to support any claim that the AMC is speeding innovation of pneumococcal vaccines, or that it is contributing to productive capacity expansion. Representatives of emerging manufacturers consistently state that the AMC is either irrelevant or inappropriate for supporting their innovative activities on pneumococcal vaccines. Acceptability and uptake of HPV vaccine in Argentina before its inclusion in the immunization program: A population-based surve y Original Research Article Pages 2467-2474 Silvina Arrossi, Veronica Maceira, Melisa Paolino, Rengaswamy Sankaranarayanan Abstract In Argentina, human papillomavirus (HPV) vaccination was approved in 2006, but not included in the National Immunization Program. In 2008 a mass media campaign was carried out by a cancer Non-Governmental Organization (NGO), but it was stopped due to criticisms about the publicity. In October 2011 the Ministry of Health (MoH) has introduced HPV vaccination in the National Immunization Program. In this context, to assure high HPV vaccine coverage, evidence is needed on factors both associated to vaccine acceptability and uptake. In 20092010 we carried out a population-based survey among a representative sample of 1200 women aged 1849 years from the Metropolitan Area of Buenos Aires. The objective was twofold: first to analyze sociodemographic determinants of women's knowledge on HPV vaccine and secondly, determinants of actual HPV vaccine uptake and acceptability in Argentina after the above-mentioned vaccine advertising shown in mass media in the year 2008. We analyzed vaccine uptake/acceptability separately for women and for their daughters aged 915, and willingness to vaccinate one's daughter younger than 9 to receive future HPV vaccination. Results of the 1200 women interviewed, 438 women (36.5%) knew the HPV vaccine and 303 (25%) remembered the mass media advertisement about HPV vaccination. When asked whether she would get vaccinated after having seen/heard the advertisement, around 75% (n = 226) of women answered surely/probably yes. No significant differences in socio-demographic characteristics were found among women who would or not get vaccinated. When surveyed, 6 women had been vaccinated. Main reasons for non-vaccination were: Doctor did not mention/recommend it (34.1%) and Vaccine is too expensive (15.7%). No woman had had their 915 year-old daughter

vaccinated. Among women who only had at least one daughter under 9 (n = 278), 74% answered that they would get their daughter vaccinated if they were pre-adolescents. The conclusion is that, in Argentina, the potential acceptability of the vaccine is high, given that there is acceptance among the professional community, physicians recommend it, and vaccine is affordable. Value in Health Vol 15 | No. 1 | January 2012 | Pages 1-214 http://www.valueinhealthjournal.com/home [Reviewed earlier] World Journal of Vaccines Volume 02, Number 01 (February 2012) http://www.scirp.org/journal/Home.aspx?IssueID=1399#17225 [Reviewed earlier]

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